Factors Associated With Neuromusculoskeletal Injury and Disability in Navy and Marine Corps Personnel

Abstract

Introduction Neuromusculoskeletal injuries (NMSKI) are very common in the military, which contribute to short- and long-term disability. Materials and Methods Population-level NMSKI, limited duty (LIMDU), and long-term disability episode counts in the U.S. Navy (USN) and U.S. Marine Corps (USMC) from December 2016 to August 2021 were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. The incidence of NMSKI, LIMDU, and long-term disability was calculated. A hurdle negative binomial regression evaluated the association of body region, sex, age, rank, age by rank, and service branch on NMSKI, LIMDU, and long-term disability incidence. Results From December 2016 to August 2021, there were 2,004,196 NMSKI episodes (USN: 3,285/1,000 Sailors; USMC: 4,418/1,000 Marines), 16,791 LIMDU episodes (USN: 32/1,000 Sailors; USMC: 29/1,000 Marines), and 2,783 long-term disability episodes (USN: 5/1,000 Sailors; USMC: 5/1,000 Marines). There was a large-magnitude protective effect on NMSKI during the pandemic (relative risk, USN: 0.70; USMC: 0.75). Low back and ankle-foot were the most common, primarily affecting female personnel, aged 25-44 years, senior enlisted, in the USMC. Shoulder, arm, pelvis-hip, and knee conditions had the greatest rates of disability, with female sex, enlisted ranks, aged 18-24 years, and service in the USMC having the most salient risk factors. Conclusion Body region, sex, age, rank, and branch were the salient factors for NMSKI. The significant protective effect during the pandemic was likely a function of reduced physical exposure and limited access to nonurgent care. Geographically accessible specialized care, aligned with communities with the greatest risk, is needed for timely NMSKI prevention, assessment, and treatment.

Differences in neuromusculoskeletal injury and disability rates between US Navy aircraft carrier and amphibious assault ships

“…10,13 Social determinants such as care-seeking behaviors, stigma, the pressure to work harder than their male counterparts, and other social pressures that may be sex related, a supposition that warrants further investigation. 3,10,13…”

“…MSKI episodes, LIMDU, and long-term disability counts were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool (MSK NEST) (Navy Bureau of Medicine & Surgery, Falls Church, VA). This surveillance tool, which has been used in prior study of MSKI in the Navy and Marine Corps, 10 leverages existing validated databases, such as the Military Health System Data Repository (MDR), LIMDU Sailor and Marine Readiness Tracker System (LIMDU SMART), Disability Evaluation System (DES) and Defense Manpower Data Center Reporting System to report injury burden in a deidentified, aggregated database. MSKI episodes within the MSK NEST were derived from healthcare encounters in the MDR and defined using the Army Public Health Center’s Taxonomy for Musculoskeletal Injuries based on an International Classification of Diagnosis, Tenth Revision (ICD-10) classification.…”

“…This finding is consistent with a prior study of sex as a factor for MSKI in Sailors using the MSK NEST database. 10 Observed sex-related differences in MSKI risk can be attributed to intrinsic biomechanical, physiological, and psychological factors, as well as extrinsic social and environmental factors that include service culture, occupational exposure, and rank. 10,13 Social determinants such as care-seeking behaviors, stigma, the pressure to work harder than their male counterparts, and other social pressures that may be sex related, a supposition that warrants further investigation.…”

“…Therefore, the purpose of this study was to evaluate the effects of ship platform on MSKI rate, limited duty (LIMDU), and long-term disability in Sailors assigned to CVNs and LHA/LHDs. Since there is a potential for sex-related differences in care-seeking for injury 10 and different environmental factors while deployed, these factors will also be evaluated.…”

CORR Insights®: Differences in Cortical Activation During Dorsiflexion and Plantarflexion in Chronic Ankle Instability: A Task-fMRI Study

“…A nkle ligament strains and sprains are one of the most common orthopaedic injuries among civilians and members of the military [4,5,11,26,32,44]. Estimated annual costs to treat these injuries are at least USD 2 billion (in 1984 dollars) [39].…”